Are you a senior citizen taking lots of medicines every day? You can now ask for a personalised pill organiser at the chemist’s

With over 10 medicines to take every day, older people – as well as those managing a chronic condition – are often at risk of getting confused, forgetting to take a pill or perhaps taking the same medication twice. That is why the service that pharmacists will be offering patients sounds like a genuinely useful (and free) one: patients will be able to access a ‘deblistering’ service at the chemist’s – the so-called deblistering – and the subsequent repackaging of medicines according to the dosages prescribed by the doctor, effectively creating a bespoke pill organiser containing the correct number and type of medicines required each day. The service forms part of local healthcare provision and is designed to facilitate the correct administration of treatment and improve patient adherence. This is provided for in the decree, signed by the Under-Secretary of State for Health Marcello Gemmato, which approves the National Guidelines for the provision of the personalised access to medicines service carried out in local pharmacies. This service, which had previously been trialled in some regions, is now being rolled out fully.

Polypharmacy – that is, the phenomenon of elderly people being prescribed numerous medicines – is very widespread in our country, which has 15 million people aged over 65, effectively one in four Italians. Indeed, as confirmed by the Italian Medicines Agency in its latest report on the use of medicines in Italia, it highlights that today one in three older people takes ten or more medicines a day. But what exactly does this service, which members of the public can access at their local pharmacy, entail? As Federfarma explains, this is a professional service specific to the sector, primarily the responsibility of the pharmacist. It is the main tool for monitoring adherence to treatment. It is undoubtedly one of the systems that provides practical help to older people or their carers in ensuring that all tablets are taken at the correct times. Take, for example, those suffering from high blood pressure, chronic obstructive pulmonary disease (COPD) or diabetes, who must take at least three medicines daily – and often many more – at different times: many get the sequence wrong or do not take their medicines as prescribed by their doctor.

The decree explains how the professional service “provided by the pharmacist, in collaboration with general practitioners and paediatricians of the patient’s choice” takes place “at the patient’s request” and consists of “the preparation of personalised packs of medicines already purchased by the patient, with the aim of facilitating the correct administration of the treatment”. But how will this personalised preparation of doses take place? The same decree explains this as an “activity consisting of removing medicines from their original packaging and subsequently repackaging them, either manually or mechanically, into personalised dosage units, within a packaging system suitable for the service provided and which is not reusable”: in practice, a pill organiser with all doses divided and sorted.

“Unpackaging,” the decree continues, “means the removal of the medicine from its secondary packaging and, where necessary, also from its primary packaging”. “This activity,” the text further clarifies, “is carried out in the pharmacy, at the patient’s request and in accordance with the treatment plan, for care purposes.” This activity is “carried out by the pharmacist under their own responsibility, with the aim of supporting the correct intake of medicines and the patient’s adherence to treatment”. Finally, the service is provided “exclusively by the pharmacy responsible for the patient, which uses only the medicines it has itself dispensed”.

As regards the safety of the operation – Federfarma adds – the Sifo Sifap protocol for hospital pharmacists is being followed, and training courses for pharmacists have also been arranged. However, it should be emphasised that the preparation of galenic formulations is already part of a pharmacist’s remit, a point also highlighted by the Council of State. When preparing a personalised dose, the pharmacist independently assesses the safety of the process based on the Summary of Product Characteristics (SPC) for each medicine: they may exclude unsuitable medicines from the deblistering process. They may suspend the preparation and contact the attending doctor should they encounter any doubts, dangerous interactions or inconsistencies in the dosage. A ‘special prescription’ specifically for deblistering is therefore not required; standard medical prescriptions, combined with the patient’s request and the pharmacist’s professional approval, are sufficient. “With this measure, we are strengthening a care model that is more closely attuned to people’s day-to-day needs, particularly those of older people – who often take several medicines a day – and their carers, who are frequently left to manage treatment on their own,” explained Gemmato. “Ensuring the appropriateness and continuity of treatment means improving patients’ quality of life and reducing the risks associated with drug interactions or errors in taking medication,” concluded the Under-Secretary of State for Health.